Access and Insurance Committee
Subject: NYS Chapter Bulletin: CMS Sleeve Non-Coverage
This NYSC Board Alert is posted to make you aware of critical coverage issues involving Sleeve Gastrectomy.
CMS has dropped the 5yr IRB Research requirement and have now given authority to the Medicare Regional Carriers to make Sleeve coverage decisions.
Dr Roslin (Chair of the Chapter Insurance Committee) wants you to be aware of the following:
- There is NO current coverage for performing Sleeves on any Medicare patient
- It is possible for you to do the surgery, receive the denial, then appeal
- Dr Roslin is communicating with the NYS-CT Regional Medical Director regarding this issue – see attached letter
Please review additional attached communication messages and copies of the recent ASMBS FAQ’s & Dr Ponce’s letter to CMS.
ASMBS and your NYS Chapter have been working on this urgent patient access issue both by providing excellent content and timely response.
The purpose of the New York State Chapter of ASMBS is to encourage members to pursue investigations both in the clinic and in the laboratory. As a group, we strive for the interchange of ideas, share information and experience pertaining to bariatric surgery, and promote improved peri-operative and long-term care of patients.
Chapter efforts focus on the reduction of patient risk, the advancement of education and educational programs for physicians, integrated health members, lay people and paramedical professionals.
- Systematic review of sleeve gastrectomy as staging and primary bariatric procedure
- Comparison Between RYGB, DS, and VSG
- Laparoscopic Sleeve Gastrectomy as an Isolated Bariatric Procedure
- A Prospective Randomized Study Between Laparoscopic Gastric Banding and Laparoscopic Isolated Sleeve Gastrectomy
- Vertical gastrectomy for morbid obesity in 216 patients
- A Prospective Multicenter Study of 163 Sleeve Gastrectomies
- Indications for Sleeve Gastrectomy as Primary Procedure for Weight Loss in the Morbidly Obese
- Type 2 Diabetes Mellitus and the Metabolic Syndrome Following Sleeve Gastrectomy in Severely Obese Subjects
- Laparoscopic Sleeve Gastrectomy – Influence of Sleeve Size and Resected Gastric Volume